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Describing Pediatric Acute Kidney Injury in the Emergency Department

Hanson, Holly R, M.D.
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1459528673

Abstract Details

2016, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Background: Acute kidney injury (AKI), caused by decreased renal perfusion or a direct kidney insult, results in increased morbidity and mortality independent of underlying disease pathology in children. Early recognition, particularly in the Emergency Department (ED), is paramount to mitigate further injury induced by nephrotoxic treatments. Diagnosis of AKI by current definition utilizing changes in serum creatinine (SCr) is challenging in the pediatric setting and can lead to delayed recognition. No studies have defined the scope of this problem from the pediatric ED. Objectives: To (1) define those children who develop AKI within 48 hours of admission from the ED and (2) ascertain patient-related factors identifiable in the ED that is associated with AKI. Study Design: This is a retrospective, observational study of children birth to 19 years of age who were admitted to a pediatric hospital from the ED between 01/2010 and 12/2013 and had a SCr drawn within the first 48 hours. Exclusion criteria included being anephric, a history of chronic kidney disease stage IV or V, or a recent admission/surgery within 72 hours of presentation. AKI was defined as a serum creatinine = 1.5 times baseline or, where baseline not present it was imputed using an estimated creatinine clearance of 120 ml/min/1.73 m2. Demographics, medical history, laboratory values, medications, procedures, and disposition were extracted. Frequencies were used to characterize the population. Differences between groups were determined by t-tests or chi-square analysis. A list of patient-related factors associated with AKI in the ED was formulated a priori based on current literature and included demographics, past medical history, past surgical history, ED procedures, ED medications, and disposition. Bivariable and multivariable logistic regression was performed to determine factors associated with development of AKI. Results: The study cohort comprised 13,827 subjects, of which 1,436 (10.4%) had AKI (34.8% were SCr = 2.0 times above baseline) and 1083 (75%) were identifiable in the ED. Of those kids with AKI, 2.7% required dialysis, 0.6% required intubation in the ED, 0.4% had inotropy started in the ED, 17.2% required central venous access, and 2.0% died during the hospital admission (all significantly more than children without AKI). Nearly 20% with AKI received a nephrotoxic medication in the ED. All factors identified a priori were entered into the bivariable model, had a p < 0.25, and then were added to the multivariable model. Young age, history of AKI, history of solid organ transplant, receiving intravenous fluids in the ED, central venous access in the ED, and admission to the intensive care unit (ICU) were all factors independently associated with AKI. Conclusions: One child per day, admitted at a large tertiary hospital, had AKI while in the ED. 25% were not identifiable by current methods. Young age, history of solid organ transplant and AKI, need for central venous access, intravenous fluid in the ED and ICU admission are all independently associated with developing AKI early. Future research should focus on improving AKI recognition in the ED by the development of a risk stratification tool.
Erin Nicole Haynes, Dr.P.H. (Committee Chair)
Lynn Babcock Cimpello, Ph.D. (Committee Member)
Marepalli Rao, Ph.D. (Committee Member)
17 p.
Surgery
Pediatrics; Acute Kidney Injury; Emergency Department

Recommended Citations

Citations

  • Hanson, M.D., H. R. (2016). Describing Pediatric Acute Kidney Injury in the Emergency Department [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1459528673

    APA Style (7th edition)

  • Hanson, M.D., Holly. Describing Pediatric Acute Kidney Injury in the Emergency Department. 2016. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1459528673.

    MLA Style (8th edition)

  • Hanson, M.D., Holly. "Describing Pediatric Acute Kidney Injury in the Emergency Department." Master's thesis, University of Cincinnati, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1459528673

    Chicago Manual of Style (17th edition)

ucin1459528673
139
© 2016, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.